Provider Demographics
NPI:1770504367
Name:DISTEL, KAREN LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNNE
Last Name:DISTEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 LOS PALOS LN
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-1034
Mailing Address - Country:US
Mailing Address - Phone:773-884-4810
Mailing Address - Fax:
Practice Address - Street 1:10201 S CICERO AVE STE A
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4672
Practice Address - Country:US
Practice Address - Phone:708-658-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-009982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist